Monday, March 25, 2024

WOMEN'S HEALTH

Rheumatic diseases associated with childbearing problems

OXFORD UNIVERSITY PRESS USA

A new paper in Rheumatology, published by Oxford University Press, finds that rheumatic diseases can lead to reproductive problems, though some conditions have more detrimental effects than others.

Immune-mediated diseases are a varied group of conditions, but each display an aberrant activity of the immune system. Some diseases, such as juvenile idiopathic arthritis and type 1 diabetes, occur mostly before patients reach their reproductive years, but others show up later in life. Scientists have investigated systemic lupus erythematosus for its impact on reproductive health; the condition increases the risk for some adverse pregnancy outcomes, including pre-eclampsia, preterm delivery, C-sections, and low birth weight. But the impact of other autoimmune diseases—such as spondyloarthritides, psoriasis, or alopecia areata—on fertility and pregnancy is unclear or the research is inconsistent.

Researchers here used data from Finnish nationwide health registers to study the impact of immune-mediated diseases on reproductive health measures such as reproductive success, and for women, ever having experienced adverse maternal and perinatal outcomes. Out of all people in Finland born between 1964 and 1984, 7.9% of the women and 7.8% of the men had an autoimmune disease diagnosed before or during reproductive years.

The researchers found that many immune-mediated diseases had little impact on the number of children. However, women with selected immune-mediated diseases experience a higher prevalence of childlessness, with the top three diseases with largest differences being Addison’s disease (23.9% more childlessness), juvenile idiopathic arthritis (9.3%), and vitamin B12 deficiency anemia (8.6%). Several of the rheumatic diseases—particularly systemic lupus erythematosus, juvenile idiopathic arthritis, and seropositive rheumatoid arthritis—lead to higher rates of childlessness and fewer children. The investigation also revealed that, on average, people with rheumatic diseases had children earlier.

The risks for pre-eclampsia, low birth weight, preterm delivery, non-elective C-sections and need of neonatal intensive care were increased for many conditions. Systemic lupus erythematosus, Sjögren’s syndrome, type 1 diabetes, and Addison’s disease showed over two-fold risks for some of these outcomes. However, the risk of gestational diabetes was not higher for patients with any of the rheumatic diseases compared to the population.

Men with rheumatic conditions also had a higher prevalence of childlessness than controls (mean difference 4.7%), with most diseases showing no difference but some diseases resulting in much higher prevalence of childlessness, with the top three diseases being myasthenia gravis (20.1% more childlessness), Addison’s disease (16.4%), and vitamin B12 deficiency anemia (13.7%).

“Despite seeing an elevated risk for diverse childbearing problems in rheumatic and other immune-mediated diseases, many of the complications are still fairly rare,” said Anne Kerola, the lead author of the study. “Family planning should actively be discussed between patients, both men and women, with rheumatic diseases and their healthcare providers. Pregnancies in women with rheumatic diseases are carefully followed up to tailor medications appropriately, which helps reduce risks.”

The paper, “Patterns of reproductive health in inflammatory rheumatic diseases and other immune-mediated diseases: a nationwide registry study,” is available (at midnight on March 20th) at https://doi.org/10.1093/rheumatology/keae122.

Direct correspondence to:
Nina Mars
Institute for Molecular Medicine Finland (FIMM), HiLIFE
University of Helsinki
Tukholmankatu 8, Helsinki, FINLAND
nina.mars@helsinki.fi

To request a copy of the study, please contact:
Daniel Luzer
daniel.luzer@oup.com

JOURNAL

Rheumatology

DOI

10.1093/rheumatology/keae122

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Patterns of reproductive health in inflammatory rheumatic diseases and other immune-mediated diseases: a nationwide registry study

ARTICLE PUBLICATION DATE

20-Mar-2024

COI STATEMENT

One of the authors has received speaker fees from Boehringer-Ingelheim and Sanofi; has participated in advisory boards of Pfizer, Gilead, and Boehringer-Ingelheim; and has received congress sponsorship from Abbvie. Another author has participated on the advisory boards of AbbVie and Amgen, received lecture fees from Boehringer-Ingelheim, Pfizer, and Abbvie, and received payment for travel expenses from Abbvie and Novartis. Another author has received lecture fees from Pfizer, Lilly, and Celltrion.

'3D mammography' almost halves the incidence of breast cancer between two screening tests

UNIVERSITY OF CÓRDOBA

Doctors Marina Álvarez and Cristina Pulido, in the Radiodiagnostic Unit at the Reina Sofía Hospital — IMAGE:
DOCTORS MARINA ÁLVAREZ AND CRISTINA PULIDO, IN THE RADIODIAGNOSTIC UNIT AT THE REINA SOFÍA HOSPITAL
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CREDIT: UNIVERSITY OF CÓRDOBA

Interval breast cancer is one that appears between two reviews of a screening program. That is, it is diagnosed after a test whose result was negative and before the next evaluation. For obvious reasons, it is a very reliable indicator of the effectiveness of early detection programs for this disease: if the number of cancers that appear after a screening is high, it is a sign that the program is not working. Conversely, if the number of tumors diagnosed after screening is low, it indicates that the program is fulfilling its function: to detect this disease at an early stage.

A clinical trial published by the University of Cordoba, the Maimonides Institute for Biomedical Research (IMIBIC) and the Reina Sofía Hospital in Cordoba, has revealed the effectiveness of breast 'tomosynthesis' in reducing by almost half the incidence of this type of cancer appearing between two rounds of screening, suggesting the advisability of including this test in a standardized way in breast cancer early detection programs.

It is a screening method complementary to traditional mammography, or '2D mammography' which, like the latter, uses x-rays. The difference is that tomosynthesis avoids the overlapping of structures and allows the lesions to be seen better when recreating a volumetric image, such that it is also known as' 3D mammography.' "Despite the fact that this technique has become widespread in diagnostic units, it is still not as standardized in screening programs," says Marina Alvarez, head of the Radiodiagnostic Unit at the Reina Sofía Hospital, one of the authors of the study and a nationally prominent figure advocating for the early diagnosis of breast cancer.

For two years, the study has worked with the population screening carried out by the Junta de Andalucía (regional government). Almost 24,000 women were examined only with 2D mammograms, while another group of 16,000 was also evaluated with breast tomosynthesis. According to the results of the work, in the first group the interval cancer rate was 1.8 per thousand people, while in the second it was 0.93. In other words, the likelihood of being diagnosed with an interval cancer was 49% lower in women who were also screened with the '3D mammogram'.

Other relevant results

As explained by the main author of the study, Cristina Pulido, the impact of tomosynthesis on the rate of interval carcinoma is even more evident in women with dense breasts, "an especially relevant fact" taking into account that "in this type of breasts, with a higher proportion of glandular tissue, it is more complicated to explore and assess the existence of lesions.

The results of the work also show that the interval cancers detected in women who have been screened with tomosynthesis are smaller than those detected in women screened with digital mammography, which is positive considering that the size of the tumors is closely related to the prognosis. This may be due to the greater diagnostic capacity of the method itself. If this technique allows for a more accurate detection of the lesions, it implies that the tumors that have gone unnoticed are smaller.

The work, in short, highlights the desirability of incorporating this test in a systematic way into the population programs for the early detection of breast cancer, an advance towards which significant steps are already being taken. "Many radiologists are already being trained in this technique. Andalusia has just renewed a significant number of mammograms with tomosynthesis, and this type of testing is already being recommended for screening," explains Dr. Álvarez.

In this way, it could further improve the diagnosis of a disease that, according to the Spanish Society of Medical Oncology, accounts for 28.9% of total cancers in women, and is the leading cause of death from cancer in this population. Despite this, survival and prognosis has improved exponentially thanks to medical advances. Everything indicates that science will continue to make progress against this disease in the years to come.
References

JOURNAL

European Radiology

DOI

10.1007/s00330-023-10546-x

ARTICLE TITLE

Interval cancer in the Córdoba Breast Tomosynthesis Screening Trial (CBTST): a comparison of digital breast tomosynthesis plus digital mammography to digital mammography alone

Is the secret to anxiety in young women hidden in our brain chemistry?

UNIVERSITY OF SURREY

The development of anxiety in girls and young women may stem from an imbalance between two crucial brain chemicals, Gamma-Aminobutyric Acid (GABA) and Glutamate, according to a new study from the University of Surrey. This discovery offers promising insights into potential treatment avenues for girls and women dealing with anxiety.

The study revealed that as young women mature, the levels of GABA (a calming brain chemical) increase, while those of glutamate, known for its role in boosting brain activity, decrease.

Dr Nicola Johnstone, a Research Fellow at the University of Surrey's School of Psychology and co-author of the study, said:

"Our research indicates that the equilibrium between GABA and glutamate in the dorsolateral prefrontal cortex serves as a vital indicator of anxiety levels. While glutamate propels brain activity, GABA acts as a brake. Our findings suggest that anxiety, often characterised by impaired rational thought, is intricately linked to the overactive braking system in the brain."

These revelations not only shed light on the underlying mechanisms of anxiety but also pave the way for targeted interventions that address the delicate balance of GABA and glutamate in the brain.

Dr Kathrin Cohen Kadosh, Associate Professor in Developmental Cognitive Neuroscience at the University of Surrey and co-author of the study, said:

"Grasping how key brain chemicals, GABA and glutamate, fluctuate during important growth stages like adolescence is vital for spotting and stopping anxiety disorders early. This study shines a light on the possibility of focusing on these brain chemicals for new treatments, particularly in young women."

By unravelling the mysteries of brain chemistry, the researchers aim to offer more effective treatments for anxiety, ultimately empowering girls and young women to lead healthier, more fulfilling lives.

The research used 81 participants from two age groups:

49 participants aged 10-12 years
32 participants aged 18-25 years

The team used a brain imaging technique called magnetic resonance spectroscopy to measure the levels of the brain chemicals in different areas of the brain.

The research has been published in Developmental Cognitive Neuroscience.

###

JOURNAL

Developmental Cognitive Neuroscience

DOI

10.1016/j.dcn.2024.101363

ARTICLE TITLE

Excitatory and inhibitory neurochemical markers of anxiety in young females

ARTICLE PUBLICATION DATE

1-Apr-2024

Laws that punish drug use during pregnancy likely lead to worse health outcomes for families

COLUMBIA UNIVERSITY'S MAILMAN SCHOOL OF PUBLIC HEALTH

March 18, 2024-- Contrary to some claims, laws that criminalize or otherwise punish drug use during pregnancy are more likely to worsen rather than improve health outcomes, according to a paper by researchers at Columbia University Mailman School of Public Health. The study is the first to systematically review the literature on punitive prenatal drug laws—an increasingly common state policy strategy for addressing rising rates of prenatal drug use. The findings are published in the International Journal on Drug Policy.

The authors collected data on the number of states with laws that explicitly allow criminal prosecution, involuntary commitment or that revoke custody rights following allegations of drug use during pregnancy. They then evaluated existing studies testing whether the enactment of such laws was associated health improvements, either for pregnant people themselves or their babies.

Of the 16 studies reviewed, the authors found that contrary to the intent of legislation, most evidence suggested that punitive laws either had no beneficial effects or made things worse. For example, four of the reviewed studies tested whether the adoption of punitive laws was associated with reductions in neonatal drug withdrawal syndrome (NDWS)—a condition that can occur after exposure to opioids and other drugs in utero. Two of the studies found little change while the two others found increased NWDS after a punitive law was adopted.

“There has been considerable concern from within legal, medical and public health communities that punitive prenatal drug policies might increase potential harms. Our findings support this premise and suggest that such approaches constitute ineffective policy,” said lead author Emilie Bruzelius, PhD, a postdoctoral research fellow in the Department of Epidemiology.

“Identifying effective policy strategies to support pregnant people with drug use disorder outside of the criminal-legal system is an important priority,” noted Silvia S. Martins, MD, PhD, professor of Epidemiology at Columbia Mailman School, and senior author.

Co-authors include Melanie S. Askari, Sandhya Kajeepta, Lisa Bates, Seth J. Prins (Columbia University Mailman School of Public Health), Kristen Underhill (Cornell University Law School), and Marian Jarlenski (Pittsburgh School of Public Health).

The study was supported by the National Institutes on Drug Abuse (R01DA045872 and R01DA053745 and T32DA031099).

Columbia University Mailman School of Public Health

Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the fourth largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master’s and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit www.mailman.columbia.edu.

JOURNAL

International Journal of Drug Policy

DOI

10.1016/j.drugpo.2024.104380

ARTICLE TITLE

Punitive legal responses to prenatal drug use in the United States: A survey of state policies and systematic review of their public health impacts

Study explores homeless women’s experiences of ‘period poverty’

UNIVERSITY OF SOUTHAMPTON

Research from the University of Southampton has identified common issues women face when experiencing periods while homeless.

A review of research published in Women and Health has found homeless women experienced practical challenges in managing menstruation alongside feelings of embarrassment and shame, with many ‘making do’ due to inadequate provision.

The researchers say it’s high time to address the provision of menstrual health resources as a basic human right.

Dr Stephanie Barker, a teaching fellow at the University of Southampton who co-led the review said: “So-called ‘period poverty’ is a global concern. Our findings highlight the need to stop gatekeeping and limiting access to menstrual health products. This is both a public health issue and a human rights one.”

The review of research evidence is the first to explore homeless women’s experiences of menstruation. The University of Southampton team identified and analysed nine studies on the topic conducted in the United Kingdom, the United States, Canada and Nepal. Three key themes emerged from the research.

The first is challenges in the logistics of managing menstruation while homeless. Finding a clean, private space to use and change menstrual products was a common issue. The few options available, such as public toilets, were described as unsanitary and not fit for purpose. The stigma attached to homelessness means women are often turned away from public and privately owned bathroom facilities.

Dr Polly Hardy-Johnson, also a teaching fellow at the University of Southampton and co-lead author on the paper, added: “Even as paying customers, women were subject to stigma around assumed drug use, limiting their access to bathrooms. Being able to pass as ‘not homeless’ was more difficult when women were unable to maintain menstrual health.

“Limited access to facilities led to infections and increased the need for costly laundry services, due to leakages and blood-stained clothing. There is a need for private, safe and clean locations for managing menstruation, as well as access to laundry facilities.”

Rough sleepers relied on service providers for menstrual products, but several studies noted that provision fell short and was sporadic. This meant women would sometimes forgo food to buy menstrual products or shoplift them.

The second theme was around feelings of embarrassment, shame and dignity linked to maintaining menstrual health. Women felt the need to hide that they were menstruating and felt judged when they could not maintain menstrual health, causing anxiety and discomfort.

Women reported services rationing free menstrual supplies, forcing them to have to ask staff (sometimes men) multiple times per day for tampons, sanitary pads, and other products.

The third theme was around women ‘making do’ to manage the challenges they were facing. Several women reported using sponges, clothes, and cut-up t-shirts as reusable ways of soaking up menstrual blood and avoiding leaks. Others used layered wads of toilet paper, and some reused soiled disposable menstrual products. To treat infections some women turned to cheap herbal remedies rather than more expensive treatments.

Studies also looked at what services the women found useful. The provision of menstrual health products and birth control products was useful, alongside sexual health services. Warm, welcoming cafes and day centres helped to soothe period pain and discomfort.

Shared information within the homeless community about the support available, showering facilities and the sharing of products helped to improve menstrual health management.

The research team found there is a lack of evidence on the experiences of homeless people who do not identify as women and who menstruate. To address this, the team has received £9.9K in funding from British Academy/Leverhulme Small Research Grants to better understand the menstruation needs of all people experiencing homelessness.

The project will conduct in-depth interviews and use creative ways to amplify marginalised voices, and co-create a policy brief with the homeless community and key stakeholders on improving access to menstrual healthcare.

The homeless period: a qualitative evidence synthesis is published in Women and Health and is available online.

Ends

Contact

Steve Williams, Media Manager, University of Southampton, press@soton.ac.uk or 023 8059 3212.

Notes for editors

The homeless period: a qualitative evidence synthesis is published in Women and Health and is available at: https://www.tandfonline.com/doi/full/10.1080/03630242.2024.2310716
For Interviews with Dr Stephanie Barker and Dr Polly Hardy-Johnson please contact Steve Williams, Media Manager, University of Southampton press@soton.ac.uk or 023 8059 3212.

Additional information

The University of Southampton drives original thinking, turns knowledge into action and impact, and creates solutions to the world’s challenges. We are among the top 100 institutions globally (QS World University Rankings 2023). Our academics are leaders in their fields, forging links with high-profile international businesses and organisations, and inspiring a 22,000-strong community of exceptional students, from over 135 countries worldwide. Through our high-quality education, the University helps students on a journey of discovery to realise their potential and join our global network of over 200,000 alumni. www.southampton.ac.uk

www.southampton.ac.uk/news/contact-press-team.page

JOURNAL

Women & Health

DOI

10.1080/03630242.2024.2310716

METHOD OF RESEARCH

Literature review

SUBJECT OF RESEARCH

People

ARTICLE TITLE

The homeless period: a qualitative evidence synthesis

Ice-ray patterns: A rediscovery of past design for the future

Research explores the geometric qualities of traditional Chinese window patterns and how they can be used in new structural designs.

XI'AN JIAOTONG-LIVERPOOL UNIVERSITY

Chinese ice-ray lattice, or "binglie" as it is called in Chinese, is an intricate pattern that looks like cracked ice and is a common decorative element used in traditional Chinese window designs.

Originally inspired by fragmented patterns on ice or crackle-glazed ceramic surfaces, the design represents the melting of the ice and the beginning of a thriving spring.

When Dr Iasef Md Rian, now an Associate Professor at Xi'an Jiaotong-Liverpool University's Department of Architecture, arrived in China for the first time in 2019, he was immediately captivated by the latticed window designs in the classical gardens of Suzhou.

"Classical gardens in China strike me as very different from the Western ones, which are more symmetrical and organised," he says. "Chinese gardens, however, have a more natural formation in their layout and design. The ice-ray window design is one of the manifestations."

Having focused on fractal geometry in architectural design for many years, Dr Rian felt an urge to explore the beauty in the patterns.

"My mind is always looking for this kind of inspiration source, so I was motivated right away to study the underlying geometric principles of the ice-ray patterns, he says."

Revealing the underlying rule

Dr Rian finds that the rule of creating ice-ray patterns is actually very simple.

He explains: "Take Type 1 as an example; a square is first divided into two quadrilaterals, and then each quadrilateral is further divided into two quadrilaterals. In each step, the proportions of the subdivided quadrilaterals are different, and this is how the random pattern is created using a simple rule.

"Through this configuration, Chinese craftsmen might have intended to increase its firmness so it can function as a window fence to provide protection. The random configuration of ice-ray lattices provides multi-angled connections, which transform the window into a collection of resultant forces and uniform stress distribution, in turn achieving a unique degree of stiffness.

"The microstructure of trabecular bone tissue in our own bodies serves as an excellent natural example of the potential of random lattices. It balances high stiffness, which contributes to strength, with a surprisingly lightweight structure."

Dr Rian recently published a paper in Frontiers of Architectural Research that explores the geometric qualities of ice-ray patterns and expands the possibilities of integrating random patterns into structural designs, especially the lattice shell design, which is often used in spherical domes and curved structures.

"In my research, I developed an algorithm to model the ice-ray patterns for lattice shell designs and assessed their feasibility and effectiveness compared to conventional gridshells. These gridshells, made from regular grids, contrast with continuous shells.

"While regular gridshells perform well under uniform loads, the ice-ray lattice offers strength under asymmetric loads. Some ice-ray patterns, resulting from optimisation, surprisingly provide better strength than regular gridshells under self-weight. There is also an additional aesthetic advantage when applying the ice-ray pattern to a lattice shell design.

"I extend the application of this pattern to curved surfaces, which helps to unlock its potential in the geometric, structural, and constructional aspects of lattice shell design," he says.

Dr Rian has also integrated ice-ray patterns and complex geometries into his teaching. In 2022, he organised a workshop for students to design ice-ray lattice roofs.

He explains that learning the concept of fractal geometry can really push the students' ideas toward a unique design.

"This is very different from what they've learned in high school. In learning to create this geometry system, they will also learn computational modelling and simulations. In the end, they'll get comprehensive knowledge of advanced architectural and digital design," he says.

Rediscovering traditional designs

To extend the research in this field, Dr Rian is investigating the effectiveness of complex geometry in various aspects like micro-scale material design and structural design.

He says: "For instance, in facade design, we usually use conventional or parametric geometry to design regular shapes. However, the random shapes designed with complex geometry can offer a more natural impression and daylight penetration."

He encourages design students and researchers to learn from the past.

"Any traditional design has a hidden rule in it. We can now use digital technologies and advanced tools to extend and expand the knowledge of traditional craftsmanship for contemporary design.

"There are many inspirations behind the traditional designs, and those principles can really inspire us designers to make innovative designs for the future," he says.

Different typologies of ice-ray lattices. P represents pentagon, Q represents quadrilaterals, and T represents triangles.

An artistic impression of the ice-ray lattice shell

Students making an ice-ray lattice roof

CREDIT

Dr Rian (XJTLU)

JOURNAL

Frontiers of Architectural Research

DOI

10.1016/j.foar.2023.12.009

METHOD OF RESEARCH

Computational simulation/modeling

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Random fractal-based computational design of an ice-ray (IR) lattice shell structure

Are there racial and ethnic differences in Medicare costs for older adults with dementia?

WILEY

In an analysis of information on Medicare beneficiaries with dementia, Medicare expenditures were higher for Black and Hispanic individuals compared with whites. The Journal of the American Geriatrics Society analysis also found that expenditures were highest for Black beneficiaries in every phase of care.

The average total Medicare expenditures after being diagnosed with dementia were $165,730 for Black beneficiaries, $160,442 for Hispanic beneficiaries, and $136,326 for white beneficiaries. In the year preceding and immediately following the initial dementia diagnosis, average Medicare expenditures for Blacks were $26,337 and $20,429, compared with $21,399 and $23,176 for Hispanics and $17,182 and $18,244 for whites. The last year of life was responsible for $51,294 in costs for Blacks, $47,469 for Hispanics, and $39,499 for whites.

Greater use of high-cost care—such as emergency department, inpatient, and intensive care—drove these differences, especially during the last year of life.

“Higher expenditures do not necessarily result in higher quality care or better outcomes,” said corresponding author Natalia Olchanski, PhD, Assistant Research Professor at the Center for the Evaluation of Value and Risk in Health at Tufts Medical Center. “Some differences in care utilization may be due to the preferences of the people with dementia and their caregivers, but the trends we identified also raise the possibility of unequal access and disparities in quality of care. It’s clear from our study that improvements are needed in all phases of care to enhance care management for people with dementia and reduce disparities for disadvantaged populations.”

URL upon publication: https://onlinelibrary.wiley.com/doi/10.1111/jgs.18822

Additional Information
NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout, newsroom@wiley.com.

About the Journal
Journal of the American Geriatrics Society is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy — all supporting the high-quality, person-centered care essential to our well-being as we age.

About Wiley
Wiley is a knowledge company and a global leader in research, publishing, and knowledge solutions. Dedicated to the creation and application of knowledge, Wiley serves the world’s researchers, learners, innovators, and leaders, helping them achieve their goals and solve the world's most important challenges. For more than two centuries, Wiley has been delivering on its timeless mission to unlock human potential. Visit us at Wiley.com. Follow us on Facebook, Twitter, LinkedIn and Instagram.

JOURNAL

Journal of the American Geriatrics Society

DOI

10.1111/jgs.18822

ARTICLE TITLE

Racial and ethnic differences in disease-course Medicare expenditures for beneficiaries with dementia

ARTICLE PUBLICATION DATE

20-Mar-2024

Racial and ethnic differences in telemedicine use

JAMA Health Forum

About The Study: The results of this study of Medicare enrollees suggest that although nationally, Black and Hispanic individuals and individuals of other racial groups received more telemedicine visits during the pandemic and disproportionately lived in geographic regions with higher telemedicine use, after controlling for geographic region, Black and Hispanic individuals and individuals of other racial groups received fewer telemedicine visits than white individuals.

Authors: Felippe O. Marcondes, M.D., M.P.H., of Massachusetts General Hospital in Boston, is the corresponding author.

(doi:10.1001/jamahealthforum.2024.0131)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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About JAMA Health Forum: JAMA Health Forum is an international, peer-reviewed, online, open access journal that addresses health policy and strategies affecting medicine, health and health care. The journal publishes original research, evidence-based reports and opinion about national and global health policy; innovative approaches to health care delivery; and health care economics, access, quality, safety, equity and reform. Its distribution will be solely digital and all content will be freely available for anyone to read.

Patient characteristics and telemedicine use in the US, 2022

JAMA Network Open

About The Study: In this study of 5,437 U.S. adults with health care visits in 2022, many patients, including those with the greatest care needs, chose telemedicine even after in-person visits were available. These findings support continuing this care delivery approach as an option valued by patients. Differences were not observed by most common measures of socioeconomic status. Continued monitoring of telemedicine use is needed to ensure equitable access to health care innovations.

Authors: Eva Chang, Ph.D., M.P.H., of Advocate Health in Milwaukee, is the corresponding author.

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(doi:10.1001/jamanetworkopen.2024.3354)

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

JOURNAL

JAMA Network Open

Does sedentary leisure time affect men’s risk of erectile dysfunction?

THERE IS A PILL FOR THAT

Peer-Reviewed Publication

WILEY

Previous research has identified genetic variants linked to sedentary leisure behavior, which includes activities such as watching television, using a computer, and operating a vehicle. In a new analysis published in Andrology, a higher genetic susceptibility to leisure computer usage was associated with a greater risk of erectile dysfunction in men.

In the analysis of data on more than 200,000 men, each 1.2 hour increase in leisure computer usage predicted 3.57-fold greater odds of erectile dysfunction. There was no evidence to suggest that watching television or driving for leisure increased the risk of erectile dysfunction. Also, computer use was not linked with depression, anxiety, or markers of blood vessel health, but it was associated with lower levels of follicle-stimulating hormone, which plays a role in sexual development and reproduction in both males and females.

“The present study offered substantial evidence for a positive causal association between computer use and the risk of erectile dysfunction. However, a definitive causal association needs to be established by further research,” the authors wrote.

URL upon publication: https://onlinelibrary.wiley.com/doi/10.1111/andr.13611

About the Journal
The field of Andrology, emerging over the last 40 years, has produced several specialty journals covering both basic scientific and clinical areas. The International Journal of Andrology began publication in 1978 and became the official journal of the European Academy of Andrology (EAA) in 1992. The American Society of Andrology (ASA) launched the Journal of Andrology in 1980. These two leading journals in the field of Andrology are now combined into a single, even more prominent journal, Andrology. Andrology serves to increase the visibility, impact and prominence of both journals, and to better promote the field of Andrology, together with the work of the EAA and ASA.

JOURNAL

Andrology

DOI

10.1111/andr.13611

ARTICLE TITLE

A Mendelian randomization study on causal effects of leisure sedentary behavior on the risk of erectile dysfunction

ARTICLE PUBLICATION DATE

20-Mar-2024

Mimicking exercise with a pill

AMERICAN CHEMICAL SOCIETY

NEW ORLEANS, March 18, 2024 — Doctors have long prescribed exercise to improve and protect health. In the future, a pill may offer some of the same benefits as exercise. Now, researchers report on new compounds that appear capable of mimicking the physical boost of working out — at least within rodent cells. This discovery could lead to a new way to treat muscle atrophy and other medical conditions in people, including heart failure and neurodegenerative disease.

The researchers will present their results today at the spring meeting of the American Chemical Society (ACS). ACS Spring 2024 is a hybrid meeting being held virtually and in person March 17-21; it features nearly 12,000 presentations on a range of science topics.

“We cannot replace exercise; exercise is important on all levels,” says Bahaa Elgendy, the project’s principal investigator who is presenting the work at the meeting. “If I can exercise, I should go ahead and get the physical activity. But there are so many cases in which a substitute is needed.”

Exercise benefits both mind and body. In this case, Elgendy, a professor of anesthesiology at Washington University School of Medicine in St. Louis, and his colleagues are hoping to recapitulate its potent physical effects — namely, exercise’s ability to enhance muscle cells’ metabolism and growth, along with improved muscle performance.

A drug that can mimic these effects could offset the muscle atrophy and weakness that can occur as people age or are affected by cancer, certain genetic conditions or other reasons they are unable to carry out regular physical activity. It could also potentially counter the effects of other drugs, such as new weight-loss medications that cause the loss of both fat and muscle, according to Elgendy.

The metabolic changes associated with exercise kick off with the activation of specialized proteins, known as estrogen-related receptors (ERRs), which come in three forms: ERRα, ERRβ and ERRγ. After about a decade of work, Elgendy and his colleagues developed a compound named SLU-PP-332, which activates all three forms, including the most challenging target, ERRα. This type of ERR regulates exercise-induced stress adaptation and other important physiological processes in muscle. In experiments with mice, the team found this compound increased a fatigue-resistant type of muscle fiber while also improving the animals’ endurance when they ran on a rodent treadmill.

To identify SLU-PP-332, the researchers scrutinized the structure of the ERRs and how they bind to molecules that activate them. Then, to improve upon their discovery and develop variations that could be patented, Elgendy and his team designed new molecules to strengthen the interaction with the receptors and thus provoke a stronger response than what SLU-PP-332 can provide. When developing the new compounds, the team also optimized the molecules for other desirable characteristics, such as stability and low potential for toxicity.

The team compared the potency of SLU-PP-332 with that of the new compounds by looking at RNA, a measure of gene expression, from about 15,000 genes in cells from rat heart muscle. The new compounds prompted a greater increase in the presence of the RNA, suggesting they more potently simulate the effects of exercise.

Research using SLU-PP-332 suggests targeting ERRs could be useful against specific diseases. Studies in animals with this preliminary compound indicate that it could have a benefit against obesity, heart failure or a decline in kidney function with age. The results in the updated research suggest the new compounds could have similar effects.

ERR activity also appears to counter damaging processes that occur in the brain in patients diagnosed with Alzheimer’s disease and those who have other neurodegenerative conditions. While SLU-PP-332 cannot pass into the brain, some of the new compounds were developed to do so.

“In all of these conditions, ERRs play a major role,” Elgendy says. “If you have a compound that can activate them effectively, you could generate so many beneficial effects.”

Elgendy and his colleagues hope to test the new compounds in animal models through Pelagos Pharmaceuticals, a startup company they have co-founded. They are also looking into the possibility of developing the compounds as potential treatments for neurodegenerative disorders.

The research was supported by the National Institute on Aging of the National Institutes of Health under Award Numbers R21AG065657 and RF1AG077160.

Visit the ACS Spring 2024 program to learn more about this presentation, “Exercise in a pill: Design and synthesis of novel ERR agonists as exercise mimetics,” and more scientific presentations.

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Title
Exercise in a pill: Design and synthesis of novel ERR agonists as exercise mimetics

Abstract
Estrogen-related receptors (ERRs) belong to the nuclear hormone receptor superfamily, a group of ligand-activated transcription factors. Ligands for nuclear receptors have the ability to either activate or inhibit the transcription factors responsible for regulating numerous genes associated with vital physiological functions, including metabolism, immunity, inflammation, homeostasis, development, cellular growth, and reproduction. Within the estrogen-related receptors subfamily, there exist three members: ERRα, ERRβ, and ERRγ. These receptors are closely related to estrogen receptors (ERs); however, ERRs exhibit constitutive activity unlike ER receptors, and can function without ligands. ERRα is known to be highly intractable as a drug target. We recently developed the first class of ERR pan agonists that was shown to induce ERRα-specific acute aerobic exercise genetic program. ERRα activation was critical for enhancing exercise endurance in mice, and our chemical tool increased mitochondrial function and cellular respiration in a skeletal muscle cell line. Using state-of-the-art computational techniques and iterative medicinal chemistry, we have identified novel chemotypes of potent ERR pan agonists with improved drug-like and pharmacokinetic properties for future use in animal models.

The progress we made in developing pan agonists that target all three isoforms of ERR is predicted to launch this target's clinical translatability. Anticipated applications for these novel ligands extend beyond their role as exercise mimetics. They hold significant potential for treating metabolic disorders, conditions linked to mitochondrial dysfunction, as well as neurodegenerative diseases.

Child Development Perspectives Journal

Q&A: Universality of executive functions: A focus on Latin America

SOCIETY FOR RESEARCH IN CHILD DEVELOPMENT

Executive functions (EFs) have been defined as the ability to regulate emotions, thoughts, and behaviors to achieve a goal. Although EFs have been identified as a cornerstone of cognitive development, knowledge of this fundamental ability in children is primarily based on research with North American and Western European samples from middle to high socioeconomic status.

A new article published in the journal Child Development Perspectives highlights the advances that have been made in developmental EFs research from Latin American
(LATAM) regions, an understudied area that provides a unique context important to understanding EFs. The findings suggest the potential for both universality and cultural specificity in EFs development.

The Society for Research in Child Development (SRCD) had the opportunity to discuss this important research and its implications with author Dr. Lucas G. Gago Galvagno from the Universidad Abierta Interamericana in Buenos Aires, Argentina.

SRCD: What sparked your interest in studying this subject?
Dr. Galvagno: My interest in studying this topic was sparked by a fascination with assessing emotional and cognitive regulation, particularly the capacity for early-life self-regulation. Recognizing self-regulation as a fundamental cognitive ability crucial for explaining overall human development, I became intrigued by the exploration of these skills from the earliest years of life. Understanding how individuals navigate and regulate their emotions and thoughts has profound implications for their overall well-being and success. Additionally, my curiosity extends to exploring the cross-cultural differences in these cognitive capacities, as it intrigues me to unravel how sociocultural and environmental factors shape the development of essential cognitive functions. Unraveling these intricacies promises not only a deeper understanding of individual development but also insights into the varied pathways that shape cognition across different countries and cultures.

SRCD: Can you please provide a brief overview of the study?
Dr. Galvagno: Most studies show consistent developmental patterns in executive function (EF) during the first 12 years, demonstrating increased cohesion, longitudinal stability, age-related improvements, and positive predictions for social and educational outcomes. However, there are also culture-specific variations influenced by sociocultural factors like social vulnerability, income inequality, educational environment, parenting styles, and regional values. To comprehensively understand EF development, a sociocultural lens is crucial, especially when considering cultural influences in Latin American countries. For example, in collectivistic cultures that tend to promote self-regulation and obedience to authorities in home and school education, children control their behavior to meet adult’s expectations. This contrasts with samples of children (1-12 years) from the United States and Western Europe, where children are possibly allowed to express their negative emotions more freely related to signs of assertion promoted in individualistic cultures.

SRCD: What is the primary takeaway?
Dr. Galvagno: The primary takeaway from this study is the recognition of the universality of executive function (EF), but also the intricate interplay between cultural, socioeconomic, and familial factors in shaping the early development of these abilities in children, particularly within the context of Latin America. By embracing this contextualized approach, we can foster more effective and inclusive pathways for supporting the cognitive and emotional development of children, promoting resilience and adaptability across diverse socio-cultural landscapes.

SRCD: Why are these findings important today?
Dr. Galvagno: Understanding the early development of executive functions (EFs) in Latin American contexts is crucial for several reasons. Firstly, replicating and extending findings from studies in Western, Educated, Industrialized, Rich, and Democratic (WEIRD) countries is essential for building a theoretical understanding of EFs that considers diverse backgrounds. Secondly, when creating programs and interventions to promote EFs, it is critical to account for the specific context of children in Latin America, considering factors such as vulnerability, lower overall levels of EFs, and a more collectivist culture. Adjusting interventions to the local context is necessary.

SRCD: How does this research differ from what’s been studied to date?
Dr. Galvagno: This research differs from previous studies in several key aspects. Firstly, it stands out for its specific focus on the development of executive functions (EFs) in the Latin American context, making a unique contribution to existing literature. Many previous studies have predominantly centered on high-income countries, and this research seeks to fill a gap by examining how sociopolitical, socioeconomic, and cultural factors specific to Latin America relate to EF development in children. Secondly, the research distinguishes itself by responding to the call from theorists advocating for a more grounded approach toEF studies in context. By doing so, it provides a more contextualized and specific perspective, recognizing the importance of understanding how the local environment influences children's cognitive development. Furthermore, the research stands out by its emphasis on exploring the relationship between universality and culture-specificity in EF development. This approach allows for discerning common patterns and cultural variations in the development of these cognitive functions, enriching our understanding of diversity in childhood cognitive development.

SRCD: Was there anything that surprised you?
Dr. Galvagno: One aspect that has consistently surprised me in these findings is the profound impact of diverse parenting styles and cultural influences on children's regulatory processes. The ongoing revelation of how different cultural backgrounds and parenting practices shape distinct forms of emotional and cognitive regulation in children continues to be astonishing. Particularly within the Latin American context, characterized by more collectivist societies and higher poverty rates compared to more central countries, children develop specific regulatory mechanisms to navigate the unique demands of their environment. It is fascinating to observe how infants in this context demonstrate adaptive forms of emotional and cognitive regulation influenced by their surroundings. For instance, in families enduring generations of poverty, there tends to be a heightened prevalence of emotional and cognitive dysregulation, also associated with lower levels of parental regulation. Unraveling these nuanced patterns sheds light not only on the resilience of children facing adversities but also on the intricate interplay between cultural and environmental factors that influence the development of essential cognitive skills.

SRCD: Who should know about these findings?
Dr. Galvagno: These findings are relevant and important for various stakeholders involved in child development, education, and policymaking. First and foremost, educators should be aware of these findings as they offer insights into the diverse ways in which children regulate their emotions and thoughts, highlighting the importance of tailoring educational approaches to individual and cultural differences. Parents can also benefit from this knowledge, gaining a deeper understanding of how their parenting styles and the cultural context may impact their child's cognitive and emotional development. Additionally, policymakers should take note, as these findings underscore the significance of considering cultural and socioeconomic factors when designing interventions and support systems for children. Finally, mental health professionals may find these insights valuable in their work, especially when working with individuals from diverse cultural backgrounds or those facing socioeconomic challenges.

SRCD: What’s next?
Dr. Galvagno: More work is needed with diverse groups of participants (children and families from rural areas, Indigenous populations, or populations of mixed ancestry, and in Central America), as well as studies that are larger, longitudinal, and with cross-cultural designs, to expand our understanding and be able to generalize results (Narea, 2016). As work in this area grows, we will be able to consider the interactions among multiple factors in the Latin American context that may affect our understanding of the development of EFs in novel ways.

JOURNAL

Child Development

DOI

10.1111/cdep.12505

ARTICLE TITLE

Importance of cultural context in the study of children's executive functions: Advances in Latin America research

ARTICLE PUBLICATION DATE

20-Mar-2024